Laying the foundations – Kate Scheer W&H UK

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  Posted by: Dental Design      19th March 2019

















The latest dental implant systems offer various benefits, perhaps the most important of which is achieving a stable, natural-looking replacement for missing teeth. Implants have consequently become a highly accepted treatment modality for partial or complete edentulism, with many patients now choosing implants over traditional alternatives such as dentures or bridges. However, the placement and restoration of an implant requires meticulous assessment and evaluation to ensure its long-term success. In particular, the condition of a patient’s jaw bone is key to achieving primary stability, which is vital to successful osseointegration.[i]

One of the challenges that practitioners face when planning for dental implant treatment is the extent of bone resorption following tooth loss. As practitioners know, natural teeth are supported and attached to the jaw bone via the periodontal ligament (PDL), which acts as a shock absorber to distribute occlusal forces and stimulate the bone. In the case of tooth loss or extraction, the bone that once surrounded the missing tooth gradually deteriorates due to a lack of stimulation. In fact, the rate of bone resorption is highest within the first six months following extraction, and proceeds at an average of 0.5% to 1.0% each year throughout an individual’s lifetime.[ii]

Although the degree of bone resorption varies from patient to patient, it will always occur to some extent unless specific care is taken to avoid it. This remains an issue even for a denture wearer, whose appliance is not in direct contact with bone and therefore doesn’t stimulate it effectively. Over time, it is the effect of mastication that causes gradual deterioration of the bone structure supporting the denture, which could alter the fit of the appliance and detrimentally affect its stability.[iii]In contrast, a dental implant is designed to mimic the function of natural tooth roots and remains stable following osseointegration with the jaw bone. Essentially, the longer a tooth is missing, the less bone is available to safely place an implant into.

In this case, bone grafting procedures may be required to ensure that the patient has adequate bone quality and quantity, which is crucial to determining the clinical success of implant treatment.iBone grafts can be carried out at the same time or prior to placing an implant. It is evidently more convenient to place an implant and perform a bone graft simultaneously – thus reducing the time required for surgery – but the clinical situation might not always allow for this. There is a variety of different bone grafting procedures that practitioners can perform and selection will depend on each case. Ultimately, the time, effort, and additional expense of successfully performing a bone graft can greatly improve the aesthetic and functional outcome of an implant – particularly if a patient is suffering from extensive bone resorption.

Once an implant is placed, everyday masticatory forces will begin to stimulate the surrounding bone, which responds by becoming stronger and denser.[iv]Yet, there is a range of external factors that can influence the future preservation of the bone. Slight bone loss over several years is considered normal and should not affect the patient’s implant directly. However, implant treatment is deemed a failure if there is bone loss of more than 1.5mm following the first year of placement, and more than 0.2mm every year after.[v]Patients who suffer from diabetes, osteoporosis, or a poor immune system are at greater risk of bone loss as they already have weak bones.[vi]

Similarly, patients with a history of periodontal disease – typically as a result of poor oral hygiene – are more likely to contract peri-implantitis, which is a common cause of dental implant failure.[vii]This inflammatory disease can damage the gingiva if left untreated, resulting in deterioration of the bone structure supporting the implant. Smokers, in particular, are in danger of developing peri-implantitis because nicotine is a vasoconstrictor that reduces blood flow, causing tissue ischemia and impaired healing of injured tissue.[viii]This can negatively impact the condition of the bone, especially in the initial stages of post-surgery healing and in the case of regeneration if a bone graft has been performed.

Essentially, without a solid foundation in which to place an implant, clinicians are unable to achieve primary stability. This emphasises the need for advanced diagnostic tools that can help guide practitioners in optimising implant treatment for both simple and complex cases. As one of the industry’s leading manufacturers, W&H offers an innovative way to do this through the Osstell range of products, including the new Osstell Beacon. This intuitive handheld device facilitates a non-invasive way of measuring primary implant stability, observing osseointegration based on secondary stability readings, and aiding practitioners in determining the best possible time for implant loading. For those seeking a complete system, the Implantmed surgical unit is available to purchase with the Osstell ISQ module already integrated. Consequently, clinicians are able to prevent implant failure, reduce healing time, and ensure the quality of treatment for highly effective, long-term results.


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[i]Javed, F., Ahmed, H. B., Crespi, R., and Romanos, G. E. (2013) Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation. Interventional Medicine & Applied Science. 5(4): 162–167. Link: [Last accessed: 19.09.18].

[ii]Pagni, G., Pellegrini, G., Giannobile, W. V. and Rasperini, G. (2012) Postextraction Alveolar Ridge Preservation: Biological Basis and Treatments. International Journal of Dentistry. 151030. Link: [Last accessed: 19.09.18].

[iii]Knezović-Zlatarić, D., Čelebić, A. and Lazić, B. (2002) Resorptive Changes of Maxillary and Mandibular Bone Structures in Removable Denture Wearers. Acta Stomat Croat. 261-265. Link: [Last accessed: 19.09.18].

[iv]Association of Dental Implantology. (2018) Bone – the foundation for dental implants. Link: [Last accessed: 19.09.18]. 

[v]Albrektsson, T., Zarb, G., Worthington, P. and Eriksson, A.R. (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Link:[Last accessed: 19.09.18]. 

[vi]Chen, H., Liu, N., Xu, X., Qu, X. and Lu, E. (2013) Smoking, Radiotherapy, Diabetes and Osteoporosis as Risk Factors for Dental Implant Failure: A Meta-Analysis. Link: [Last accessed: 19.09.18].

[vii]Prathapachandran, J. and Suresh, N. (2012) Management of peri-implantitis. Dental Research Journal. 9(5): 516-521. Link: [Last accessed: 19.09.18].

[viii]Kasat, V. and Ladda, R. (2012) Smoking and dental implants. Journal of International Society of Preventive & Community Dentistry. 2(2): 38-41. Link: [Last accessed: 19.09.18].

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